Exercise Pulmonary Hypertension Predicts Clinical Outcomes in Patients With Dyspnea on Effort

Abnormal pulmonary arterial pressure (PAP) responses to exercise have been described in select individuals; however, clinical and prognostic implications of exercise pulmonary hypertension (exPH) among broader samples remains unclear. This study sought to investigate the association of exPH with cli...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2020-01, Vol.75 (1), p.17-26
Main Authors: Ho, Jennifer E., Zern, Emily K., Lau, Emily S., Wooster, Luke, Bailey, Cole S., Cunningham, Thomas, Eisman, Aaron S., Hardin, Kathryn M., Farrell, Robyn, Sbarbaro, John A., Schoenike, Mark W., Houstis, Nicholas E., Baggish, Aaron L., Shah, Ravi V., Nayor, Matthew, Malhotra, Rajeev, Lewis, Gregory D.
Format: Article
Language:English
Subjects:
Adult
Age
Aged
Blood pressure
Cardiac output
Cardiology
cardiovascular disease
Catheters
Chronic obstructive pulmonary disease
Clinical outcomes
Confidence intervals
Dyspnea
Dyspnea - diagnosis
Dyspnea - epidemiology
Dyspnea - physiopathology
exercise
Exercise Test - methods
Exercise Tolerance - physiology
Family medical history
Female
Follow-Up Studies
Health hazards
Heart attacks
Heart failure
Hemodynamics
Hospitalization
Hospitals
Humans
Hypertension
Hypertension, Pulmonary - diagnosis
Hypertension, Pulmonary - epidemiology
Hypertension, Pulmonary - physiopathology
Lung diseases
Male
Medical records
Mercury
Middle Aged
Mortality
Peptides
Predictive Value of Tests
Prospective Studies
Pulmonary arteries
Pulmonary hypertension
Respiration
Therapeutic applications
Treatment Outcome
Veins & arteries
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Summary:Abnormal pulmonary arterial pressure (PAP) responses to exercise have been described in select individuals; however, clinical and prognostic implications of exercise pulmonary hypertension (exPH) among broader samples remains unclear. This study sought to investigate the association of exPH with clinical determinants and outcomes. The authors studied individuals with chronic exertional dyspnea and preserved ejection fraction who underwent cardiopulmonary exercise testing with invasive hemodynamic monitoring. Exercise pulmonary hypertension was ascertained using minute-by-minute PAP and cardiac output (CO) measurements to calculate a PAP/CO slope, and exPH defined as a PAP/CO slope >3 mm Hg/l/min. The primary outcome was cardiovascular (CV) hospitalization or all-cause mortality. Among 714 individuals (age 57 years, 59% women), 296 (41%) had abnormal PAP/CO slopes. Over a mean follow-up of 3.7 ± 2.9 years, there were 208 CV or death events. Individuals with abnormal PAP/CO slope had a 2-fold increased hazard of future CV or death event (multivariable-adjusted hazard ratio: 2.03; 95% confidence interval: 1.48 to 2.78; p 
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2019.10.048